In a speech delivered to a conference in Sydney this week, Telstra's business division head Deena Shiff has called for a review of the basis on which doctors are paid and for the removal of existing barriers blocking the uptake of new technologies such as videoconferencing. Along with related facilities, such as the ability to transmit X-ray or other scan images over fast data connections, these allow patients in rural areas -- or their general practitioners -- to consult medical specialists hundreds or even thousands of kilometres away.
"The basis on which medical professionals are rewarded acts as a drag on innovation in delivering clinical services; it effectively deters them from making full use of the available technology," she says. "The basis on which doctors are remunerated ... needs to be reviewed to remove barriers to use of technology."
Under present Medicare rules, rebates are not payable for consultations where doctor and patient are not physically present in the same room. And, with only a few exceptions, Medicare will pay only for services provided by one doctor or health provider with the same patient at the same time, discouraging a rural GP or specialist from accompanying a patient to a telehealth consultation with a city-based specialist consultant.
In her address to the National Telemedicine Summit, Shiff said despite these restrictions the technology necessary was well-developed and remote diagnosis "is not a technology fantasy of the future, it is happening now".
One example is breast cancer, as mobile screening vans already transmit scan results to city-based radiologists for analysis.
In the Northern Territory, a doctor in the community of Oenpelli is planning to use a recently laid fibre-optic link to conduct consultations with specialists at the Royal Darwin Hospital for patients with traumatic injury, and will be able to transmit X-ray images and hold videoconferences with medical colleagues to discuss patient treatments.
Nurses on home visits can use e-health technologies to access patient records, while potential applications include using Bluetooth connections to a home monitor to measure blood sugar or send heart-rate measurements to a mobile phone.
Shiff says most private doctors are small businesspeople who cannot justify investing in equipment capable of enabling e-health consultations if payment mechanisms do not exist that will allow them to recoup outlay.
"In most cases the lack of a business model is impeding take-up," she says. "Home care requires someone to take responsibility for care co-ordination and to ensure that the data is correctly collected at the point of care. Even if this role is to be fulfilled at public expense or on a voluntary basis, it is difficult to build a business model around it."
Similar criticisms of Australia's slow uptake of modern communication tools in healthcare settings have been made previously by medical experts.
In a paper published in the Medical Journal of Australia in January, experts from the University of Queensland say the uptake of telemedicine has been "disappointingly slow" in light of its benefits, which include an "enormous potential to improve equity of access to health services in a cost-effective manner". Payment mechanisms need to be changed and new services should be integrated with existing outreach services and thoroughly evaluated to provide the evidence of their cost-effectiveness, they say (MJA 2009;190(1):15-19).
Peter Brooks, executive dean of health sciences at the University of Queensland, said at the time that the barriers to greater uptake of telemedicine included the "lack of understanding and acceptance by the health professions and governments" about the potential for telehealth.
"Governments need to look at how these new technologies can help, and then play a co-ordinating or facilitatory role, encouraging partnerships between universities and health departments, but most of all ensuring that these services are funded properly with the creation of new Medicare rebates," Brooks said.
"We (also) need to educate the profession and, importantly, patients about opportunities that exist to make their lives easier and more connected, particularly in rural and remote Australia."
Shiff says the National Health and Hospitals Reform Commission had identified the problem in its recent interim report.
She says many commonly cited features -- including video consultations and transmission of electronic records -- already are possible on the company's existing broadband wireless network.
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Autor(en)/Author(s): Adam Cresswell
Quelle/Source: The Australian, 21.03.2009
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